MindSpinner

In my area, there hasn’t been anything in the papers about bird flu in weeks. The mayor of our small town hems and haws and says we have a plan. (I called him.) Apparently this plan doesn’t involve, to date, clueing anybody in or advocating personal preparedness in a public forum. It would be incredibly easy not to know a thing about bird flu in my town, and, in fact, many people, if my kids’ friends and their families provide a clue, haven’t heard much about it. We are sitting ducks, so to speak.

But there are things worth knowing.

It’s worth knowing that, in certain Indonesian cases, viral loads in the nose and throat have been much higher than usual with H5N1, potentially increasing the transmissibility of the virus. (See Declan Butler’s blog and the upcoming issue of Nature.) It’s worth knowing that genetic sequences in human cases of H5N1 in Indonesia aren’t exact matches for genetic sequences of avian cases of H5N1 in Indonesia, calling into question whether people are actually catching the virus from birds. (See “What’s New” at Recombinomics. I’d like to see this confirmed by more than one source and to better understand what it means.)

It’s worth knowing that, in Thailand, villagers are ignoring warnings and eating their dead birds. (Human behavior - forgive me for stating the obvious - will have a good bit to do with outcomes.)

WHO, though definitely not telling us everything we need to know, is warning that this flu season will likely see an increase in the number of cases of H5N1. Tomorrow, according to the Financial Times (subscribers only), Europe’s disease control agency will warn governments to step up their preparations for bird flu because the virus could mutate into a form more dangerous to humans in the near future. When our own government is busy stockpiling anti-virals and printing more cash in anticipation of a possible pandemic, one has to guess that something may be up.

I let lots of flower seedlings grow in my garden this year. Sometimes my seedlings are markedly different from their parents, and the differences introduce delightful variety. In a virulent flu, inevitable mutations are that virus’s endless and mindless experimentation with a view toward survival and conquest. Every human being who comes down with H5N1 is a viral lab working 24-7.

I’ve weathered hurricanes (as a child) without undue fear. Back in ‘99, I figured we’d head off the Y2-K mess successfully. We could depend on our best minds. I am not panic-prone. But I respect this virus, and I’ve come to believe the odds are significantly in its favor.

I’d like to say I’ve been able to prepare my little family for the possibility of a pandemic, but the notion that three weeks worth of food in the guest room closet constitutes preparedness is naive. I have, however, done a batch of research and a little buying, with more to be stretched out over the next six months. (I haven’t even started to look at what we might keep on hand to help with treatment should one of us get sick, mainly because there don’t seem to be any magic bullets.) A concise and admittedly partial summary follows because, who knows, somebody might benefit from it.

Preparation lists can be found everywhere and are generally overwhelming. Here’s a useful approach to buying food and one for emergency supplies. The first things to buy are the things that will be out of stock when WHO raises the alert level and people begin scrambling to prepare.

How a pandemic plays out would depend on both the infection rate and the fatality rate of the pandemic strain. Predictions abound that enough people may be sick, caring for the sick, or hiding from the virus to make life problematic. Supply chains may break down, and basic services may be spotty, so it’s best to have a plan to deal with those possibilities.

Clean Water (gotta have it):

Reputable water purifiers can be had from Katadyn and British Berkefield. These do not filter viruses, of course, so water must still be boiled, pasteurized in a solar cooker, treated with plain bleach or water tablets, or sterilized with a nifty little gizmo called a SteriPen, available from REI. (REI also sells a variety of water purifiers.)  Storing some water in containers designed for that purpose is also a fine idea, depending on space available.  (Don’t drink from your rain barrel.)

Cooking:

I like the Volcano Stove or Volcano Stove II because it functions efficiently using charcoal, propane or even wood as fuel. Since propane would likely become a coveted and scarce commodity were lots of people depending on it, I like the fact that the Volcano Stove uses about 1/3 of the charcoal a regular grill might and will cook using wood as well. (Charcoal stores indefinitely, if kept dry. Kingsford charcoal is recommended, along with a Weber Chimney Starter.) The Volcano Stove is not, however, an indoor stove. At my house, I’d have to use it in the garage with the windows and the door to the dogs’ yard open for cross-breeze ventilation. I’m even more fond of box solar cookers, which can be made or bought. There are simpler panel solar cookers that can likewise be constructed or purchased very inexpensively. The catch is that there’s no cooking on rainy or heavily clouded days and, again, one has to cook outside.  I’d like to use a solar cooker whenever possible and a Volcano Stove only when the solar cooker isn’t an option.

Heat:

What I really want is a clean-burning wood stove with a pellet insert so that the house could be warm, but what I’ve got is a Coleman ProCat Propane Heater which will warm a small area for as long as my as yet nonexistent store of propane canisters lasts.  (An alternative is a Mr. Heater Portable, which can be used with a 20 lb. propane canister parked outside a window. But it can be harder to light.) I picture us huddling in a tent in the house (ventilated, of course), with Mylar space blankets over the top of the tent to keep the heat in.  I’m wondering just how much heat could be stored in bricks painted flat black, laid outside in a kind of oversized solar oven improvisation, and brought in when the sun goes down.  Maybe enough to stretch the propane?

The annoying thing about propane, kerosene, and the like is their limited shelf life - two years for propane, one year for kerosene and diesel, six months for gasoline.

Refrigeration (not):

There are highly efficient refrigerators that will run off a single solar panel, but, you guessed it, these are expensive - utterly out of the question in this house.  If the power goes, refrigeration is not an option.  Some improvisation is possible with simple root cellars or a variation based on placing a smaller clay pot inside a bigger clay pot with wet sand between the two and a damp cloth for cover.  Since this low-tech arrangement works in Africa to keep produce fresh longer (much longer), it will probably work just about anywhere. To view the technique and results on the site linked above, click to the third and then fourth square buttons.

Gardening:

Instead of mulching the bare spaces in my kitchen garden this fall, I’m working in more organic material and planting fall crops here and there instead - onions, leeks, spinach, (in shade, given the heat), and carrots.  Winter squash are already up, prepared to take off and take over in every direction.  Construction of new beds will continue, but I’m afraid I’m going to have to buy a saw to get them done. Our local Lowes is only going to cut so much lumber for me, even if the shop teacher who works there apparently thinks I’m cute.  Besides, their saw has been out of commission for a week, and summer’s slipping away. I’m nowhere near being able to raise enough food to survive, but I like the idea of having fresh produce to supplement what would attenuate to a diet of beans and rice.  I’m betting that certain crops could weather the winter here in Zone 6, given protection.  I’ve opted for relatively inexpensive alternative to a greenhouse or cold frame, just for a couple of 8′ beds.

The best books I’ve found on gardening (I’m learning lots) have been Ed Smith’s Vegetable Gardener’s Bible and Sally Jean Cunningham’s Great Garden Companions. I’m also mining Eliot Coleman’s Four Season Harvest for ideas about how to keep some fresh vegetables on the table year round, though sections about building greenhouses aren’t relevant to my circumstances.

Laundry:

Options include a big mop bucket with a wringer or a WonderWash hand-operated washer with enough capacity for one or two outfits at a time.  Reviews by users indicate, however, that it does a good job.

Power & Light:

If I had lots more money than I do, I’d buy a Brunton Solar Roll to power my laptop. I’ve collected lots of useful information on that laptop, in a NoteTaker notebook. Thanks to my generous and ingenious brother who made some excuse about a late Christmas gift, we now have a Brunton Solar Port 4.4 portable power source with a battery charger, which will recharge AA batteries, charge a cell phone, and, with an adapter, even provide the laptop limited juice. For light, a solar lantern supplements flashlights and a small battery-operated lantern that run off AA batteries. I figure a pandemic won’t make the sun go out; better yet, the sun won’t send me a bill. A generator, on the other hand, is not an option - too pricey and inevitably dependent on available and affordable fuel besides. 

There’s much more to say about preparation, and there are lots of places where it’s all being said, but immersion in such sites eats up a lot of time and can become an unhealthy obsession, so I’m outta here. There’s a holiday to enjoy.

If H5N1 never becomes a human pandemic (I’m mourning independently for the birds), I’ll be all set to take a back woods camping trip in some gorgeous place where I can take lots of pictures.

I’ve had to change my WordPress options today to require registration and log-in before readers can comment here. I usually have to delete 50-100 comments a day queued fairly harmlessly in “moderation,” but when I get 2365 instances of comment spam in a day, such that my browser crashes in the attempt to select them for deletion, measures must be taken :->. Those who occasionally post genuine comments, know that your responses are always appreciated here. I hate to have to put up an extra hurdle for you to jump through in order to make a comment, but the only other alternative right now is turning off comments altogether.

Among the most emailed articles at the NY Times today is this one: “Use of Antipsychotics by the Young Rose Fivefold.” It begins, “The use of potent antipsychotic drugs to treat children and adolescents for problems like aggression and mood swings increased more than fivefold from 1993 to 2002, researchers reported yesterday.” I can hear the clucking now. What is this nation doing to its children? But the closest depiction of truth cannot lie at the top of an inverted pyramid article, in the lead. One comes nearer to it only by drilling down.

In the new study, about a third of the children who received antipsychotics had behavior disorders, which included attention deficit problems; a third had psychotic symptoms or developmental problems; and another third were suffering from mood disorders. Over all, more than 40 percent of the children were also taking at least one other psychiatric medication.

“We feel the medications are effective in children with bipolar and have some data to show that,” said Dr. Melissa DelBello, an associate professor of psychiatry at the University of Cincinnati, who has done several studies of the drugs.

Dr. DelBello said that the field “desperately needs more research” to clarify the effects of the antipsychotic drugs but that many children struggling with bipolar disorder got more symptom relief on these drugs than on others, allowing psychiatrists to cut down on the overall number of medications a child is taking.

Lisa Pedersen of Dallas, the mother of a 17-year-old boy being treated for bipolar disorder, said he was unpredictable, hostile and suicidal before psychiatrists found an effective cocktail of drugs, which includes a daily dose of antipsychotic medication.

“Believe me, I would never choose having him on these meds,” Ms. Pedersen said in a telephone interview. “It’s not fun watching a child deal with the side effects. But finding the right combination of medicine has made his life worth living.”

Yet this process is one of trial and error for many children. Ms. Pedersen said her son had responded badly to the first two antipsychotic drugs he received. And some experts think the way that psychiatric drugs are prescribed is obscuring any understanding of underlying disorders and the optimal treatments.

“If you’re going to put children on three or four different drugs, now you’ve got a potpourri of target symptoms and side effects,” said Dr. Julie Magno Zito, an associate professor of pharmacy and medicine at the University of Maryland.

Dr. Zito added, “How do you even know who the kid is anymore?”

When do you put your kid on a drug like Ritalin or Adderall?
When you know his ADD or ADHD will otherwise hopelessly undermine his education.

When do you put your kid on an antidepressant that means you’ll be watching her closely for a couple of weeks for suicidal thinking?
When you are pretty damned sure that her life is at greater risk should you do nothing.

When do you put your kid on an antipsychotic with potentially nasty side effects?
When he’ll never have a normal life unless you can get his symptoms under control.

When do you put your kid on a cocktail of drugs that make her very personality seem like a chemical experiment?
When you recognize that your child’s real personality has already been missing in action, maybe for years, replaced by the manifestations of a disorder that is already brain chemistry gone wrong, when talk therapy can’t even start to help until brain chemistry is at least partly righted, and most of all when your child’s life borders on the unlivable otherwise.

It is easy to lament the five-fold increase in the use of antipsychotic medications in young people. But it is impossible to judge, from the outside, the decisions of individual parents and physicians who struggle to find solutions so that troubled young people can aspire to livable lives imbued with a measure of hope.

The search for what works for an individual child is often a matter of trial and error, of weighing the costs and benefits of any course of treatment, of hoping that someday we’ll be able to ascertain just what is out of kilter and how to right it. Solutions are hardly ever found solely in pill bottles, but some solutions in difficult cases, if there are solutions to be had, have as an essential component powerful medications we would otherwise not think of giving to our children.

To those who say, “I can’t imagine giving my children drugs like these,” I can only say, and this from the heart, “I hope you never have to.”

This commentary at Recombinomics.com notes how W.H.O. is playing the numbers game with the flu pandemic alert level. If you don’t want to change the number, it seems, you just tweak the definitions of the current level as evidence of human-to-human transmission mounts. (Note: Recombinomics was founded by Dr. Henry Niman to further the study of how viruses evolve. Here and elsewhere, Dr. Niman questions W.H.O.’s rendition of the evolutionary state of H5N1, the bird flu.)

The moves to watch may be the ones that don’t make the headlines, such as the U.S.’s deployment of some of its Tamiflu supplies to address the bird flu threat in Asia.

The United States has sent a supply of Tamiflu to Asia to help the region prepare for a human outbreak of avian influenza, U.S. Health and Human Services Secretary Mike Leavitt said on Monday.

“I am not going to specify the amount or the location, but I want to make clear that we are beginning to deploy it,” he said

The deployment of Tamiflu treatment courses to Asia is cause for concern. Tamiflu supplies in the United States are below those of most industrialized countries, so deployment from the US signals a potentially serous situation.

If nobody’s willing to say how much Tamiflu is being shipped and where, there’s got to be a reason for that. The old dependable one, that information could aid our enemies, seems dubious when the enemy is a virus. No doubt widespread alarm causes problems in and of itself, and governments would like to fight containment battles without also having to worry about the disruption fear causes, especially to economies and big business. On the other hand, gradually raising the alert level to reflect actual state of the H5N1 threat would likely generate the waves of preparation that might mitigate the tsunami of chaos that will follow should H5N1 materialize as a pandemic.

For its part, W.H.O. is hardly pooh-poohing the threat, described as “serious.” The W.H.O. bird flu FAQ outlines in broad terms how flu pandemics unfold.

Influenza pandemics are remarkable events that can rapidly infect virtually all countries. Once international spread begins, pandemics are considered unstoppable, caused as they are by a virus that spreads very rapidly by coughing or sneezing. The fact that infected people can shed virus before symptoms appear adds to the risk of international spread via asymptomatic air travellers.

The severity of disease and the number of deaths caused by a pandemic virus vary greatly, and cannot be known prior to the emergence of the virus. During past pandemics, attack rates reached 25-35% of the total population. Under the best circumstances, assuming that the new virus causes mild disease, the world could still experience an estimated 2 million to 7.4 million deaths (projected from data obtained during the 1957 pandemic). Projections for a more virulent virus are much higher. The 1918 pandemic, which was exceptional, killed at least 40 million people. In the USA, the mortality rate during that pandemic was around 2.5%.

Pandemics can cause large surges in the numbers of people requiring or seeking medical or hospital treatment, temporarily overwhelming health services. High rates of worker absenteeism can also interrupt other essential services, such as law enforcement, transportation, and communications. Because populations will be fully susceptible to an H5N1-like virus, rates of illness could peak fairly rapidly within a given community. This means that local social and economic disruptions may be temporary. They may, however, be amplified in today’s closely interrelated and interdependent systems of trade and commerce. Based on past experience, a second wave of global spread should be anticipated within a year.

As all countries are likely to experience emergency conditions during a pandemic, opportunities for inter-country assistance, as seen during natural disasters or localized disease outbreaks, may be curtailed once international spread has begun and governments focus on protecting domestic populations.

Unfortunately, the time to prepare for the possibility of a flu pandemic is before it’s clear to everyone that immediate preparation is necessary. That’s when there’s suddenly not enough of anything. I’ve read enough now to sigh and start making a list of what I’ll buy using this year’s tax refund. I’d rather be caught prepared for a disaster that never comes (insofar as one can prepare) than unprepared for a disaster that does. Beyond that, one has little control.

Growing up, I confronted time and again two possible reactions one can have to those situations over which one finally has little control. Middle-of-the-night tornado warnings offer an example. (Hurricanes offer another; but this post is already long.) My father stayed up as late as necessary on stormy nights to hear the weather reports on the radio. Whenever a tornado warning was announced, he would herd us out of bed and down to the basement to install us in the Olds ‘98. He had a plan. When the whole house fell in on us, we would plow our way out in the big car. We were probably the only peole in the county sitting in our car in our basement during tornado warnings. He spent every moment tightly wound with anxiety, as if vigilance could change the course of a funnel cloud. My mother cooperated with the car plan, which my father thought a stroke of genius, but she had the gall to bring a pillow and fall asleep, if she could, while the storm reverberated all around the house. It wasn’t that she was oblivious; she was just willing to accept that there wasn’t anything more to be done; that what would be would be. I learned from both of them - from my father the importance of strategizing and preparation, from my mother a certain peace that comes when all is done that can be done and matters are out of our hands.

I’ve been following the Avian flu now for some months, as have a lot of people, and have thought about what we’ll do should a pandemic erupt and in preparation for that possibility.

The New York Times reports today what people who follow flu sources already know - that human-to-human transmission of the virus is likely already occurring, though not on a grand scale. Consider this case:

Dr. Niman contends that the largest human-to-human cluster so far was not in Indonesia, but in Dogubayazit, Turkey, in January. W.H.O. updates recorded 12 infected in three clusters, and quoted the Turkish Health Ministry blaming chickens and ducks. Dr. Niman counted 30 hospitalized with symptoms and said the three clusters were all cousins with the last names of Kocyigit and Ozcan, and that most fell sick after a big family party on Dec. 24 that was attended by a teenager who fell sick on Dec. 18 and died Jan. 1.

A patriarch, Dr. Niman said, told local papers that the two branches had had dinner together six days after the 14-year-old, Mehmet Ali Kocyigit, had shown mild symptoms. He died on Jan. 1, and several other young members of the two families died shortly after, with other relatives showing symptoms until Jan. 16. No scientific study of that outbreak has been released.

Ironically, there is no move to raise W.H.O.’s alert level from 3 to 4. Here’s the reasoning:

Dr. David Nabarro, chief pandemic flu coordinator for the United Nations, said that even if some unexplained cases were human-to-human, it does not yet mean that the pandemic alert system, now at Level 3, “No or very limited human-human transmission,” should be raised to Level 4, “Increased human-human transmission.”

Level 4 means the virus has mutated until it moves between some people who have been only in brief contact, as a cold does. Right now, Dr. Nabarro said, any human transmission is “very inefficient.”

Let me see now, 30 people got sick after being exposed to the virus by one teenager in the early stages of an illness that would kill him days later. I can’t remember attending any family reunions where 30 people caught a cold from cousin Sammy, who showed up with the sniffles. I’d say that strain of H5N1 moved from human to human nimbly indeed.

As long as numbers are small, maintaining the current alert level may have more to do with forstalling alarm and its consequences than it does with the question of whether the H5N1 virus is capable of moving readily from person to person.